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Abstract

During the last decades medical school curricula have been reformed to put more focus on building students’ practical skills. In the course of these reforms new teaching methods were employed, among them simulation. By now, simulation is a widely used training method, especially in the area of anesthesia. It currently still suffers from two sets of problems, namely the lack of a learning theoretical foundation and thorough evaluation studies. The current study revised an existing basic anesthesia skills simulation curriculum based on an instructional model for the development, delivery, and evaluation of medical simulation training (Schaper, Schmitz, Graf & Grube, 2003). The original version of the training (TG 0) was compared with two instructionally revised versions (TG 1 and 2). The revised curriculum was designed following an integrated approach to learning (Reinmann-Rothmeier & Mandl, 2001). Accordingly, the didactic strategy of the simulation training’s preparatory seminar for TG 1 and 2 was revised to combine constructivist (e.g., problem-based), and traditional e.g., lecture-based) elements. The full-scale simulation sessions for TG 1 and 2 were revised based on the cognitive apprentice-ship approach (Collins, Brown & Newman, 1989) to provide a constructivist learning environment with instructional support. In addition to these changes, the sequence of the curriculum’s elements was varied for TG 2. Before participating in the full-scale complete-task simulation sessions, TG 2 participated in part-scale part-task emergency simulation training. The evaluation of the revised training programs yielded the following main results: The three groups reacted positively to the training but did overall not differ in their reactions. The revisions of the preparatory seminar did not lead to the expected increase in self-reported learning. The revisions of the full-scale simulation sessions and the change in the curriculum’s elements’ sequence led to more self-reported learning for TG 2. Ratings by the instructors supported this result by showing that TG 2 was better prepared for the simulation sessions. On the transfer level, assessed by the students’ OSCE results, TG 2 also received the best ratings. A set of students’ individual characteristics and key relations between the model’s elements were also investigated: Students’ readiness and expectation fulfillment were positively influenced by respective interventions. Students’ readiness, expectation fulfillment, instrumentality expectancy, and self-efficacy predicted their training reactions. The study thus corroborated that simulation training is a viable method to build students’ basic anesthesia skills. It provided first indications that a simulation curriculum based on a theoretically founded model improves training effectiveness and that individual characteristics influence simulation outcomes. Stricter designs are needed to extend the study’s findings.